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Health Care Tour: “Seeking Patient-Centered Care”
Piedmont Orthopedic Associates - Greenville
The Issue:
- A leading orthopedic practice gives its perspective on the challenges facing our health care system.
Findings:
- An Overview of the Clinic:
- The practice needs 6 support employees for every 1 physician (3 are needed exclusively for billing and insurance).
- Piedmont Orthopedics employs 90 people.
- Piedmont refers most complex imaging, but they perform some x-ray services.
- Patient Coverage Breakdown:
- 1/3 Medicare
- 1/3 BlueCross BlueShield
- 1/3 Workers’ Compensation
- Costs are rising…
- Health Care costs have gone up because of technological advancements. One example from the orthopedic field: traction used to be the only therapy for compressed spinal cords, now surgical implants are a possibility.
- Overhead and malpractice insurance costs continue to rise. Piedmont used to offset these costs with secondary profit centers (i.e., on-site physical therapy clinics), but federal regulation made that illegal.
- Increased access and better technology now means higher costs. This year Americans will get 500,000 knee replacements. In 25 years, that number is expected to be 3.5 million.
- While reimbursement is falling…
- As technology advances, Medicare reimburses less for services.
- Example: Piedmont would typically charge $1200 for an MRI. Medicare will reimburse $300 for an MRI.
- Doctors are stuck in the middle.
- The doctors are reaching a tipping point where they just won’t take Medicare patients anymore, and the government will soon realize that there’s a big access problem for Medicare beneficiaries.
- Piedmont Orthopedics is the only orthopedist in the Upstate still taking TRICARE patients – but that is only out of concern for the troops. TRICARE is not profitable for the practice.
- There used to be alternative opportunities in the system for doctors to make a profit. Those opportunities are gone, and now doctors are forced to see as many patients as possible in order to make money.
- Piedmont Orthopedic sees challenges:
- High costs affecting the system. Previously, the health care system promised quality care for next-to-nothing.
- “If people think they can pay less than they do now and still receive the same consumer-driven services – they’re wrong.”
- To overcome those challenges, Piedmont Orthopedic foresees changes:
- Start applying judgment to distributed care.
- Those with unhealthy habits should not be driving up others’ health care costs from large medical bills due to their behavior.
- Start making hard decisions that the America public may not want to hear at first, but will adjust to over time.
When: Thursday, March 27, 2008
Where: 35 International Drive, Greenville, SC 29615
Attendees: Chris Kavolus, M.D. (Hip and Knee Replacement Surgery), Stephen Ridgeway, M.D. (Hip and Knee Replacement Surgery), Arnold Batson, M.D. (Hand and Upper Extremities Surgery), John Vann, M.D. (Sports Medicine and Arthroscopy), Bland Burkhardt (Practice Administrator)